**2.9 Protein sparing modified diet**

Combination of low carbohydrate ketogenic diet and very low calorie diet. Patients prescribed this diet are started off on a very low calorie diet (800 calories/ day) for the first six months and then the calories are increased gradually. At the beginning carbohydrate intake is limited to 20-50 g/day with 1.2–1.5 g/Kg of proteins [19]. Successful in weight loss and lowering HbA1C and fasting glucose. However, there is a low adherence rate among patients and they may increase weight regain quickly [10].
